COST-BENEFIT-ANALYSIS OF PHARMACOLOGICAL HEMOSTASIS

Background. Surgical bleeding with possible associated coagulopathies is a major source of morbidity and mortality. More than 27% of patient s receive unnecessary blood or blood-product transfusions during cardi ac operations. Analysis of the cost-benefit of pharmacologic hemostasi s can be accomplished by relating all the components of cost, which in clude both direct and indirect costs to both direct and indirect benef its to the patient. Methods. A significant reduction in transfusion re quirements can be achieved by the systematic application of a clinical algorithm. An alternative is to use drugs that enhance hemostasis. Fo ur such drugs commonly used are desmopressin acetate, tranexamic acid, E-aminocaproic acid, and aprotinin. All these agents have been shown to successfully reduce bleeding and the need for transfusion. It appea rs that the order of efficacy (greatest to least) is aprotinin, tranex amic acid, E-aminocaproic acid, and desmopressin acetate. Results. Cos t/benefit analysis associated with the use of these agents is complex. The direct costs of these drug treatments can be balanced against the costs related to blood and blood-product administration. Using epsilo n-aminocaproic acid, blood used is valued at $30, whereas the drug tre atment cost is less than $2. Aprotinin use results in costs of more th an $500, with the drug costing $900. Conclusions. Improved hemostasis should also result in indirect cost savings from reduced operating roo m time, reduced intensive care unit and hospital stay, and the avoidan ce of reoperation for bleeding.